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1. You are evaluating a 75-year-old man with recently diagnosed prostate cancer and 2 painful metastases of the lumbar spine. Which one of the following therapeutic options is the most appropriate?
A) Surgical castration (orchidectomy)
B) Fentanyl patch and breakthrough opioids
C) Oral anti-androgen plus gonadotropin-releasing hormone agonist
D) Palliative radiotherapy to the lumbar spine
E) Intrathecal steroid injection
2. An 80-year-old woman presents to your office with weight loss and generalized weakness. Her husband calls you after the appointment and asks that his wife not be told if she is diagnosed with cancer as hearing this will likely " kill her. " Investigations subsequently show that she has metastatic lung cancer. Which one of the following is the best next step?
A) Telephone her to inform her she has a bad pneumonia and prescribe antibiotics.
B) Arrange an urgent consultation with her children to confirm her wishes.
C) Book an immediate appointment with your patient.
D) Tell the patient she requires a computed tomography scan of the chest.
E) Tell her husband she has metastatic lung cancer.
3. A 14-year-old girl, accompanied by her mother, presents to your office with a 3-month history of feeling " dizzy. " After you take an initial history, which one of the following is the most appropriate next step?
A) Obtain growth parameters and vital signs
B) Perform a detailed cardiac and neurological examination
C) Interview the girl without the mother present
D) Order a urine pregnancy test
E) Do a bedside glucometer reading
4. A 50-year-old man with prostate cancer, which is complicated by bony and cerebral metastases, presents to your office. He has a 24-hour history of increasing lower back pain and weakness in his legs. On examination, you note decreased knee and ankle reflexes on both sides. Earlier today he had fecal incontinence. Which one of the following is the best next step?
A) Dose of parenteral steroids.
B) Bed rest with subcutaneous analgesia.
C) Consult to surgery.
D) Consult to radiotherapy.
E) Stellate ganglion block.
5. A 66-year-old woman with metastatic breast cancer presents with hard, difficult-to-pass stools. She has been experiencing this issue since starting morphine to control her pain. Which one of the following is the best next step?
A) Prescribe senna
B) Start docusate
C) Lower her morphine dose
D) Suggest increasing her physical activity
E) Add a bulk-forming fiber supplement to her diet
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: C | Question # 3 Answer: C | Question # 4 Answer: A | Question # 5 Answer: A |
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